Voters should recognize this fact as they elect a president, and state lawmakers should acknowledge it as they decide whether to adopt a federally funded expansion of Medicaid.

In less politically charged times, people would understand the life-saving benefits of public and private insurance intuitively.

A person who can't afford to visit a doctor for the flu sometimes develops pneumonia and sometimes dies. When the cost is too high, people are less likely to check out the suspicious lump or urinary discomfort and are thus less likely to discover the cancer while it is treatable.

Uninsured people with diabetes tend to forego treatment, which can lead to fatal heart disease.

While hospital emergency rooms cannot turn away uninsured patients, they can and do bill them.

The prospect of bankruptcy sometimes prevents people from seeking needed emergency care.

It is thus no surprise that, when states increase Medicaid coverage, their mortality rates drop. When New York, Maine and Arizona expanded coverage, their mortality rates decreased by 6.1 percent.

Insurance coverage may partly explain why Alabama - which has a high percentage of uninsured residents - has a life expectancy of 75.

Massachusetts and Canada - both of which have universal coverage - have life expectancies of 81.

When Mitt Romney claims, "We don't have people that become ill, who die in their apartment because they don't have insurance," he is correct if he is speaking only of those people who have such high incomes they can easily absorb medical costs. But that does not describe incomes of most Alabamians.

The mere fact that insurance saves lives does not mean we should ignore the costs of providing coverage. Even lives must be balanced against finite state and federal budgets.

Voters should understand, however, that electing candidates who promise to repeal the Affordable Care Act means more people will die.

Similarly, Alabama lawmakers should recognize that a refusal to expand Medicaid will cost lives. The federal government will pay for all of the cost of expanded coverage for three years, and at least 90 percent thereafter.

While the state should not forego a cost-benefit analysis just because lives are at risk, it needs to examine all benefits. A study in Michigan, released Tuesday, concluded the expansion would save state dollars by shifting expenditures for mental health services and medical care for prisoners to the federal government.